Critical pathways in cardiology
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Comparative Study
The "rule of halves" does not apply in Peru: awareness, treatment, and control of hypertension and diabetes in rural, urban, and rural-to-urban migrants.
To determine the awareness, treatment, and control of hypertension and diabetes by migration status. ⋯ These results identify major unmet needs in awareness, treatment, and control of hypertension and diabetes. Particular challenges are lack of awareness of both hypertension and diabetes in rural areas, and poor levels of treatment and control among people who have migrated from rural into urban areas.
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To study the reperfusion strategies currently being used in the treatment of ST-elevation myocardial infarction (STEMI) at an academic medical center in a developing country and to analyze the door-to-balloon time (DBT) in those patients undergoing primary percutaneous coronary intervention (PCI). ⋯ There was a significant increase in the utilization of primary PCI for reperfusion of STEMI in this academic medical center in a developing country. However, achieving a target DBT ≤90 minutes was suboptimal. Future studies are needed to analyze the logistic factors associated with delayed reperfusion to institute policies and systems that can enhance the efficacy of primary PCI as a reperfusion modality in these countries.
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Telemetry monitoring is often overused in the inpatient setting. This has led to overcrowding of telemetry beds, increased wait times in the emergency department, and inefficient allocation of hospital resources. The American College of Cardiology/American Heart Association (ACC/AHA) guidelines exist to guide appropriate utilization of cardiac monitoring. We sought to investigate the effect of the institution of an electronic ordering system (EOS) on adherence to guideline-based telemetry use. ⋯ The institution of an EOS significantly improved compliance with ACC/AHA guidelines for cardiac monitoring at the time of admission. However, compliance worsened after the initial 48 hours, which may have been due to the ease of online reordering with our EOS. Clinically significant events were only observed in patients who met criteria for monitoring. EOS can be a useful tool to improve adherence to guideline-based utilization of hospital resources.
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Epidemiological studies have demonstrated racial disparities in the workup of emergency department patients with chest pain and the referral of admitted patients for intervention. However, little is known about possible disparities in stress test utilization in low-risk chest pain patients admitted to emergency department chest pain units. ⋯ Our study confirms racial disparities in the utilization of stress testing in the chest pain unit. Further investigation is needed to identify specific provider or patient-level factors that may contribute to this disparity.
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Prognostication beyond troponin levels in patients with acute atrial fibrillation (AF) is still unclear. ⋯ In patients with acute AF, abnormal troponin levels add prognostic value to clinical parameters in the short term; dysglycemia and known vascular disease in the long term.